Provider Demographics
NPI:1558428961
Name:PREFERRED BEHAVIORAL HEALTH OF NJ
Entity Type:Organization
Organization Name:PREFERRED BEHAVIORAL HEALTH OF NJ
Other - Org Name:WRAP AROUND PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGELINI
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:732-458-1700
Mailing Address - Street 1:PREFERRED BEHAVIORAL HEALTH OF NEW JERSEY
Mailing Address - Street 2:P.O.BOX 2036
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701
Mailing Address - Country:US
Mailing Address - Phone:732-458-1700
Mailing Address - Fax:732-785-3296
Practice Address - Street 1:591 LAKEHURST ROAD
Practice Address - Street 2:PREFERRED BEHAVIORAL HEALTH OF NJ WRAP AROUND PROGRAM
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753
Practice Address - Country:US
Practice Address - Phone:732-458-1700
Practice Address - Fax:732-785-3296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0018872Medicaid
NJ526788Medicare ID - Type UnspecifiedAGENCY #